Rural America is facing an existential crisis. As cities continue to grow and prosper, small towns are shrinking. That fundamental divide played itself out in the recent presidential election.

Consider this shocking chart produced by the Brookings Institution. It shows that, in 2000, George W. Bush won 2,397 counties (compared to Al Gore's 659), and those counties represented 46% of America's GDP. Fast forward to 2016. Donald Trump won an even larger share: 2,584 counties (compared to Hillary Clinton's 472). Yet, counties that voted for Trump accounted for only 36% of the nation's GDP. Since most Bush counties also voted for Trump, that means -- in a span of just 16 years -- economic productivity shifted by 10 percentage points, away from small town America and toward the big cities1.

From 1999 to 2015, suicide rates increased everywhere in America. On average, across the U.S., suicides increased from 12.2 per 100,000 to 15.7 per 100,0002, an increase of just under 30%. However, in rural America, the suicide rate surged over 40%3, from just over 15 per 100,000 to roughly 22 per 100,000. Similarly, the suicide rate in micropolitan areas (defined as having a population between 10,000-49,999) went from 14 per 100,000 to 19 per 100,000, an increase of around 35%.

On the flip side, major cities saw much smaller increases in suicide rates, on the order of 10%. The graph depicts a clear pattern: Suicide rates are highest in the most rural parts of the country, and they slowly decrease as urbanization increases. As of 2015, the suicide rate in rural areas (22 per 100,000) is about 40% higher than in the nation as a whole (15.7 per 100,000) and 83% higher than in large cities (12 per 100,000).

What explains the difference? The CDC suggests lack of proper mental healthcare, social isolation, the opioid crisis, and lingering effects of the Great Recession, all of which hit rural areas hardest. It appears fixing the suicide epidemic will require addressing very large societal trends and cultural problems.

Notes

(1) Updated March 30, 2017: It was brought to my attention that George W. Bush won several large counties that Donald Trump did not. This probably accounts for the majority of the 10-point "drop" in GDP. However, it is still true that the economy is shifting away from rural areas and toward the large cities.

(2) These numbers were obtained from WISQARS, using the same data adjustments as reported in the CDC graph.

(3) The CDC did not provide exact numbers in this report, so these figures are obtained from reading the graph.

Dr. Alex Berezow joined the American Council on Science and Health as Senior Fellow of Biomedical Science in May 2016. In December 2018, he became Vice President of Scientific Affairs.

Dr. Berezow is a featured speaker for The Insight Bureau, an international speakers' bureau. He also features twice weekly on the Kirby Wilbur Show, a Seattle area radio program, in a segment called "Real Science with Dr. B."

Dr. Berezow is a prolific science writer whose work has appeared in multiple outlets, including The Wall Street Journal, CNN, BBC News, The Economist, Forbes, Scientific American, and USA Today, where he serves as a member of the Board of Contributors. He has authored or co-authored three books: The Next Plague and How Science Will Stop It (2018), Little Black Book of Junk Science (2017), and Science Left Behind (2012), which was an environmental policy bestseller.

Dr. Berezow has spoken to a wide variety of audiences about science, from graduate school seminars and church congregations to national TV and radio programs. Formerly, he was the founding editor of RealClearScience. He holds a Ph.D. in microbiology.

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